Session-by-session change in misophonia: A descriptive case study using intensive CBT

Abstract

There is preliminary evidence that CBT may be helpful for improving symptoms of misophonia, but the key mechanisms of change are not yet known for this disorder of decreased tolerance to everyday sounds. This detailed case study aimed to describe the delivery of intensive, formulation-driven CBT for an individual with misophonia and report on session-by-session outcomes using a multi-dimensional measurement tool (SFive). The patient was offered 12 hours of treatment over five sessions, using transdiagnostic and misophonia-specific interventions. Reliable and clinically significant change was found from baseline to one-month follow-up. Visual inspection of outcome graphs indicated that change occurred on the 'outbursts' and 'internalising appraisals' SFive subscales following assessment, and on the 'emotional threat' subscale after the first treatment session. The other two subscales started and remained below a clinically significant level. The biggest symptom change appeared to have occurred after the second session, which included interventions engaging with trigger sounds. The results demonstrated the individualised nature of misophonia, supporting the use of individually tailored treatment for misophonia and highlighting the importance of using a multi-dimensional measurement tool. Key learning aims (1) To understand misophonic distress from a CBT perspective. (2) To learn a formulation-driven approach to misophonia. (3) To apply transdiagnostic interventions to misophonia. (4) To learn about misophonia-specific interventions. (5) To consider the value of a multi-dimensional measure of misophonia.